Active management of labour: current knowledge and research issues

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Abstract
Objectives : To review the evidence that the package of labour interventions collectively called “active management” - namely, strict diagnostic criteria for labour, early amniotomy, early use of oxytocin, and continuous professional support - reduce rates of caesarean sections and operative vaginal delivery in first labours. Design : Review of observational data, supplemented by evidence from four separate overviews of relevant randomised trials previously published as part of the Cochrane Collaboration pregnancy and childbirth database. Results : Observational data do not permit a clear conclusion. There have been no randomised trials of the total package of active management or of the use of strict diagnostic criteria alone, but trials of early amniotomy, early oxytocin, and these interventions combined do not suggest that these interventions are effective in reducing rates of caesarean sections or operative vaginal deliveries. In contrast, the provision of continuous professional support in labour seems to reduce both types of operative delivery, although the effect on caesarean sections is confined to those settings where non-professional companions are not normally present in labour. Conclusions : Delivery units should endeavour to provide continuous professional support in labour, but routine use of amniotomy and early oxytocin is not recommended.